Original ResearchFull Report: Clinical—Alimentary TractMany Patients With Irritable Bowel Syndrome Have Atypical Food Allergies Not Associated With Immunoglobulin E
Graphical abstract
Section snippets
Participants
Patients who believed that their symptoms were related to food ingestion4; fulfilled the IBS Rome III criteria10; and had moderate to severe daily symptoms for at least 1 year, as verified by Francis IBS symptoms score and visual analogue scale (VAS) well-being score questionnaires (see Supplementary Materials) were included in the study. Esophagogastroduodenoscopy/colonoscopy results were normal, and inflammation/infection markers in serum/stool, total IgE, IgE serum antibodies to common food
Results
A total of 170 IBS patients were enrolled into the study (95 female; age range, 18–76 years; mean age, 44.4 ± 15.4 years). Eleven patients had other diseases, such as mastocytosis or endometriosis, among others, or became pregnant; 4 had serious clotting disorders. Of the remaining 155 patients, 47 did not complete the full study because they regarded this as either too cumbersome or because symptoms improved with the first randomly assigned diet, resulting in refusal to continue with the
Discussion
Although pathophysiological understanding of the spectrum of IBS remains incomplete, it is generally accepted that activation of the innate and acquired immune system is involved, finally leading to chronic intestinal low-grade inflammation.
This study confirms and expands our previous report9 suggesting that at least 50%–60% of IBS patients may have a nonclassical food allergy. Notably, all patients displayed a negative response to food antigens on classical food allergy testing (skin-prick
Acknowledgments
Author contributions: Annette Fritscher-Ravens: study concept and design, oversaw study, performed endoscopies, wrote manuscript; Theresa Pflaum: immunohistochemistry and histology, clinical assessment of patients; Marie Mösinger: clinical patient assessment; performed eosinophil count, tryptase, ECP measurements; statistics: Zino Ruchai: clinical patient evaluation and follow-up, CLE image interpretation, questionnaire evaluation, statistics; Chirstoph Röcken: oversaw all histology, guided
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Conflicts of interest The authors disclose no conflicts.
Funding The work was supported by the Rashid Hussein Charity Trust, Kuala Lumpur, Malaysia to Annette Fritscher-Ravens and by research grants from the German Research Foundation (DFG Schu 646/17-1, DFG Schu 646/20-1) and from the Leibniz Foundation (Wheatscan, SAW-2016-DFA-2) to Detlef Schuppan. The sponsor has no involvement in the study.